Minority report on childbirth procedures by government senators

Government Senators opposed the establishment of this inquiry for a number of reasons.

As many witnesses remarked, this issue has had many inquiries undertaken by various governments and other bodies. All the inquiries seem to be repetitive and draw roughly the same conclusions.

Probably most importantly however, it was opposed on the basis that most, if not all, of the inquiry was outside the jurisdiction of the Federal Government and that the Federal Government should not be dictating to the States how they should be running services that fall within their responsibilities.

The other major factor in such a decision by Government Senators was that it was clear that the issues under scrutiny that did not involve the States were ones for the medical profession and patients - not for senators. By this we cite by example the expressed view on Caesarean sections.

While many are concerned about the number of surgical interventions we believe that such decisions are not for medically unqualified senators to make without the knowledge of a patient’s particular circumstances. Those types of decisions (and many like them) should be clinical decisions made by doctors in consultation with their patients and based on clinical need.

We believe that for members of parliament to start dictating who should or should not have particular procedures, access to certain tests, the frequency of specific tests, or the like is not only unwise but undesirable.

There is much in the Report of the Opposition Senators that can be supported purely as general observations and reservations or concerns however, that does not mean that Senate Committees can somehow start and dictate to others what should or should not happen. The parliament does not seek to interfere with other medical or surgical procedures or tests that are deemed necessary by treating medical practitioners. Childbirth procedures where there are medical or surgical implications should be regarded no differently.

For example, there have been marked increases over the last one to two decades in cardio-thoracic tests, surgery and preventative treatments as procedures have been developed and refined. There has not been a suggestion that the parliament should somehow influence those clinical decisions or any other decisions where the numbers of procedures has grown markedly. Childbirth procedures should be no different.

When one looks at the recommendations they basically come down to a ‘wish list’. Very few of them have anything to do with the Federal Government. Many that request the Federal Government to act are asking for the Federal Government to cut across areas of direct State responsibility. Two such examples are the suggestion that the Patient Assistance Travel Scheme be extended for friends or relatives of patients and ‘that hospitals fund existing birthing centres and establish others’.

Others are requests that have no organisation or person/s to execute the request.

Others are asking for statistics on procedures and events that are already readily available. Such a recommendation states ‘that adequate funding be provided to develop and support consistent, reliable and timely data collection on maternal and perinatal morbidity and mortality’. That information is already provided annually by the Australian Institute of Health and Welfare.

There are, of course, a number of recommendations that suggest government intervention in clinical decisions with which government senators cannot agree. The suggestion in the recommendation of Opposition senators that a target rate of 15% for Caesarean sections should be established is untenable because it ignores the question of what happens after that figure has been reached. Patients needing or wanting such a procedure cannot be asked to come back ‘next year’?

Additionally, there are some recommendations for the government to take certain initiatives that have already been taken by the Coalition government such as those relating to the provision of services to Aboriginal and Torres Strait Islanders and visiting doctors to rural and remote areas. We are amazed that such significant policy initiatives have been overlooked by the Opposition Senators.

The Federal Government has already put $8.2 million into a Fly-In Fly-Out female GP service for women living in rural and remote Australia. This measure was announced in the 1999-2000 Budget. Female GP’s will visit up to 160 locations nationally about four times a year, complimenting the outback clinics offered by the Royal Flying Doctor Service and other agencies. One, but not the only, reason is to give women an opportunity to discuss conditions such as contraception and gynaecological and obstetric care with a female doctor if they prefer.

Over time it is hoped the service will provide valuable research about the health needs of rural women, laying the basis for future improvements in treatment and care.

This service is among a raft of Federal Government health initiatives funded by a $200 million budget commitment to improve access to medical care in rural and regional Australia.

We express concern that so many personal opinions have been quoted in the Opposition Report as evidence with inadequate qualification that it is not necessarily accepted by the Committee as fact.

We do hope that the State Governments will focus upon and implement many of the initiatives that have been proposed over the years as a result of previous inquiries. Australians deserve and expect safe outcomes from all medical episodes.

Senator Sue Knowles, Deputy Chairman Senator Tsebin Tchen

(LP, Western Australia) (LP, Victoria)

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